Your Name or Company Name   

Your Address

Your City, TX Zip

Your Phone Number &(111 ) xxx-xxxx Fax: (xxx) xxx-xxxx

 

Today’s Date

Postmaster/Office

Xxx, TX 7xxxx

City, State, Zip Code

 

Request for Change of Address or Boxholder

Information Needed for Service of Legal Process

 

Please furnish the new address or name and street address (if a boxholder) for the following:

 

Name:              

 

Address:   

 

The following information is provided in accordance with 39 CFR 265.6(d)(5)(ii).  There is no fee for providing boxholder information.  The fee for providing change of address information is waived in accordance with 39 CFR

265.6(d)(1) and (2) and corresponding Administrative Support Manual  352.44a and b.

 

  1. Capacity of requester: Process Server.

 

  1. Statute or regulation that empowers me to serve process: Texas Rules of Civil Procedure Rule 103.

 

  1. The names of all parties to the litigation:                      

 

  1.  The court in which the case has been or will be heard:

 

  1. The docket or other identifying number if one has been issued:  

 

  1. The capacity in which this individual is to be served (e.g. defendant or witness):

 

WARNING

THE SUBMISSION OF FALSE INFORMATION TO OBTAIN AND USE CHANGE OF ADDRESS INFORMATION OR BOXHOLDER INFORMATION FOR ANY PURPOSE OTHER THAN THE SERVICE OF LEGAL PROCESS IN CONNECTION WITH ACTUAL OR PROSPECTIVE LITIGATION COULD RESULT IN CRIMINAL PENALTIES INCLUDING A FINE OF UP TO $10,000 OR IMPRISONMENT OR (2) TO AVOID PAYMENT OF THE FEE FOR CHANGE OF ADDRESS INFORMATION OF NOT MORE THAN 5 YEARS, OR BOTH (TITLE 18 U.S.C. SECTION 1001). 

    

I certify that the above information is true and that the address information is needed and will be used solely for

Service of legal process in connection with actual prospective litigation.

 

 

_____________________________                            Your address again here

Signature                                                              City, TX 7xxxx

Print your name here                                                              

_____________________________________________________________________________________________

FOR POST OFFICE USE ONLY

                                                                                    

 NEW ADDRESS or BOX HOLDER’S       POSTMARK

___ Not known at address given.                           

___ Moved, left no forwarding address.   

___ No such address.                                             NAME and STREET ADDRESS

___ No change of address order on file.                                                                   

                                                                                _________________________________________

 

                                                                                _________________________________________

 

                                                                                _________________________________________